Melbourne School of Population and Global Health - Theses
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ItemA study of the effect of adverse psychosocial work stressors on health and mortality( 2021)The working environment is central in the lives of individuals in employment, influencing health outcomes including psychological and physical well-being. Psychosocial work stressors are common exposures in the workplace and are important and modifiable determinants of health and health behaviours. There is broad agreement in the literature that exposure to adverse psychosocial work stressors, such as high job demands, low job control, low job security and high effort-reward imbalance are associated with poor health outcomes. All of these exposures are, in turn, associated with unhealthy behaviours such as smoking, alcohol consumption, poor diet and inactivity, and to the development of hypertension, cardiovascular disease, diabetes, musculoskeletal disorders and depressive disorders. Psychosocial work stressors have been identified as significant emerging risks linked to global changes in the structure, organisation and management of work during previous decades, presenting pressing challenges to occupational health and safety and workplace health, in general. Most of the literature in this area assesses disease incidence or other morbidity outcomes, with a growing number of studies focusing on mortality. However, whether exposure to these psychosocial work stressors associated with adverse health outcomes translates into increased mortality remains unclear, and barriers to making causal interpretations about the relationship between psychosocial work stressors and health persist, mostly due to inherent biases in the methodology across studies. In this thesis, the effect of exposures to psychosocial work stressors in the working environment such as job control, job demands, job strain, long working hours, job insecurity and shift work on health and mortality were investigated. A comprehensive systematic review including meta-analyses of the epidemiological research was conducted. Panel data from the Household, Income and Labour Dynamics in Australia survey was used to capture natural experiments of psychosocial work stressors associated changes in health and well-being, and mortality to investigate whether and how the effect of psychosocial work stressors on mortality differ in relation to demographic and socioeconomic characteristics. The initial focus of the research included establishing and quantifying the risks associated with adverse psychosocial work stressors, which workers are commonly exposed to in the workplace, on mortality. The final study in the PhD focused on understanding the exposure-outcome dynamics. The dynamics of the connexions between psychosocial work stressor perceived job control and general health, a strong predictor of future morbidity and mortality, were investigated for evidence of a causal relationship. The first study showed that improving the quality of work might contribute to better health and well-being and decrease the effect of psychosocial work stressors on all-cause mortality and cardiovascular disease mortality. If this observed association is causal, then policy and practice interventions to improve job control could contribute to reductions in mortality. Study II adds to the growing body of evidence showing an effect of adverse psychosocial work stressors on mortality. Study III showed that long-term exposure to low job control and job security was associated with increased risk of all-cause mortality. In Study IV, the dynamics of job control and general health were explored for evidence of a causal relationship using three complementary longitudinal modelling approaches. This study, using improved causal inference methods than previous research, showed that increased job control was strongly associated with increasing general health. Although the estimates for the single measures suggest modest increases in the risk of death and poor health, this translates to large population impacts because the exposures are relatively common across the working population. Thus, reducing exposure to psychosocial work stressors associated with mortality and poor health could have considerable public health benefit. Awareness by stakeholders, government and organisations of the implications of the adverse effects of psychosocial work stressors on health and mortality in workplaces; and the availability appropriate, evidence-based work stress interventions to reduce the exposure to work stressors might contribute to better health and well-being, reduce sickness absence and presenteeism to the benefit of workers, workplaces and society.